Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark.
School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong.
BJOG. 2019 Jan;126(1):55-63. doi: 10.1111/1471-0528.15433. Epub 2018 Sep 19.
To investigate long-term pattern of mortality in menopausal women according to different modalities of hormone therapy.
Population-based prospective cohort study.
Denmark 1993-2013.
A total of 29 243 women aged 50-64 years at entry into the Diet, Cancer and Health Cohort, enrolled 1993-97 and followed through 31 December 2013.
Cox' proportional hazards models for increasingly longer periods of follow-up time were used to estimate mortality pattern according to baseline hormone use adjusted for relevant potential confounders.
MAIN OUTCOME(S): All-cause and cause-specific mortality. Outcome information was obtained from the Danish Register of Causes of Death (linkage 99.6%).
A total of 4098 women died during a median follow up of 17.6 years. After adjustment for relevant lifestyle risk factors, hormone use had no impact on all-cause mortality, regardless of modality. Among baseline users, lower cardiovascluar disease mortality was only evident after 5 years [hazard ratio (HR) 0.54; 95% CI 0.32-0.92], but dissipated with additional follow up. Conversely, lower colorectal cancer mortality (HR 0.64; 95% CI 0.46-0.89) and higher breast cancer mortality (HR 1.34; 95% CI 1.05-1.72) only became evident after 15 years of follow up. There were no significant associations for mortality from other types of cancer or from stroke.
In this long-term follow-up study, taking hormones during menopause was not associated with overall mortality among middle-aged women. Investigating cause-specific mortality revealed significant, albeit weak, differential associations according to both causes of death and over time, underlining the importance of carefully considering individual risks and duration of treatment when making decisions on hormone therapy.
Long-term follow-up study confirms no association between menopausal hormone therapy and overall mortality.
根据激素治疗的不同方式，研究绝经后妇女的长期死亡率模式。
基于人群的前瞻性队列研究。
丹麦 1993-2013 年。
共有 29243 名年龄在 50-64 岁的女性，于 1993-97 年进入饮食、癌症和健康队列，随访至 2013 年 12 月 31 日。
使用 Cox 比例风险模型，根据基线激素使用情况，调整相关潜在混杂因素，估计随访时间逐渐延长后的死亡率模式。
全因死亡率和死因特异性死亡率。结局信息来自丹麦死因登记处（链接率 99.6%）。
共有 4098 名女性在中位随访 17.6 年后死亡。在调整相关生活方式危险因素后，无论激素治疗方式如何，激素使用对全因死亡率均无影响。在基线使用者中，仅在 5 年后才能观察到心血管疾病死亡率降低[风险比（HR）0.54；95%可信区间（CI）0.32-0.92]，但随着随访时间的延长而消失。相反，15 年随访后，结直肠癌死亡率降低（HR 0.64；95%CI 0.46-0.89）和乳腺癌死亡率升高（HR 1.34；95%CI 1.05-1.72）才变得明显。其他类型癌症或中风的死亡率没有显著相关性。
在这项长期随访研究中，绝经后使用激素与中年女性的总体死亡率无关。对死因特异性死亡率的调查显示，尽管存在差异，但根据死亡原因和随时间的变化，存在显著的差异，这突出了在决定激素治疗时，仔细考虑个体风险和治疗持续时间的重要性。
长期随访研究证实，绝经后激素治疗与总体死亡率之间没有关联。
